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Patient comments “I think I had a review but I don’t remember” “I feel aftercare was lacking, although the hospital was brilliant” “I don’t feel like I can trouble anyone” “Just left to it” “I’ve just carried on” “Practice nurse good point of contact and know patient well” “We soldiered on” “I’ve been in a black hole since treatment” “No contact from GP surgery” “Saw GP who said I needed antibiotics, didn’t ask about cancer – no interaction, would have been nice” “I didn’t know I could get a free wig on the NHS” “I had lymphoedema, I wasn’t told about skin care or how I could massage my arm”. “Many ladies feel isolated at the end of treatment”

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Patient comments If CCR routinely carried out, how soon after diagnosis should it be offered? “Once treatment has started” “The offer of a review needs to be soon” “About 6 months after diagnosis, you need to come to terms with things” “ASAP”

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Patient comments cont. Did you find CCR with the nurse a positive or negative experience overall? Why? “Positive but came a little late for me” “Positive; it was good to talk to someone who understands your position, and who is not a friend or relative” “Positive; the nurse showed genuine sympathy in my situation, giving relevant leaflets and a support service if needed”

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Patient comments cont. One model of care would be to have a telephone call at the point of diagnosis by a doctor or nurse and offered a more detailed CCR at about 6 months, comments? “A call from the surgery would be good as I felt a little that my doctors just forgot me”. “Phone call initially ok, but not the same as face to face. I also think 6 months is too long. I had a family and friends, not everyone has”. “Depends on the individual, the option could be offered”. “Before 6 months ASAP after diagnosis. Support is of the upmost (It can be a very stressful and anxious time)”.

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Summary 1.QOF payments are significantly lower than for other chronic diseases, consider best practice 2.All patients are individuals with very different supportive needs 3.Practice nurses are ideally placed to support cancer patients 4.Enhanced CCR ensures a holistic approach to care and support